LANDOWNER
A statement duly acknowledged before an officer authorized to take acknowledgement of Deeds and signed by all Landowners. This statement shall be signed and dated on or after the last change or revision to said plan.
A. Individual - Certification of Ownership, Acknowledgement of the Plan, and Offer of Dedication.
Commonwealth of Pennsylvania
County of Perry
On this, the day of , 20 , before me, the undersigned officer, personally appeared who being duly sworn according to law, deposes and says that he is the of the property shown on this plan, that he acknowledges the same to be his act and plan, that he desires the same to be recorded, and that all streets and other property identified as proposed public property (excepting those areas labeled “not for dedication” are hereby dedicated to the public use.
Signature of Landowner
Signature and Seal of Notary Public or Other Officer Authorized to Acknowledge Deeds
My Commission Expires , 20
B. Co-Partnership - Certification of Ownership, Acknowledgement of the Plan, and Offer of Dedication.
Commonwealth of Pennsylvania
County of Perry
On this, the day of , 20 , before me, the undersigned officer, personally appeared , being of the firm of who being duly sworn according to law, deposes and says that the co partnership is the of the property shown on this plan, that the plan thereof was made at its direction, that it acknowledges the same to be his act and plan and desires the same to be recorded, and that all streets and other property identified as proposed public property (excepting those areas labeled “not for dedication”) are hereby dedicated to the public use.
Signature of the Individual
Signature and Seal of Notary Public or Other Officer Authorized to Acknowledge Deeds
My Commission Expires , 20
C. Corporate - Certification of Ownership, Acknowledgement of the Plan and Offer of Dedication.
Commonwealth of Pennsylvania
County of Perry
On this, the day of , 20 , before me, the undersigned officer, personally appeared , being of (Name of Corporation), who being duly sworn according to law, deposes and says that the corporation is the of the property shown on this plan, that he is authorized to execute said plan on behalf of the corporation, that the plan is the act and deed of the corporation, further acknowledges, that all streets and other property identified as proposed public property (excepting those areas labeled “not for dedication”) are hereby dedicated to the public use.
Signature of the Individual Corporate Seal
Signature and Seal of Notary Public or Other Officer Authorized to Acknowledge Deeds.
My Commission Expires , 20
SURVEYOR, ENGINEER AND/OR LANDSCAPE ARCHITECT STATEMENT OF ACCURACY
A. Survey Certification of Accuracy.
I hereby certify that, to the best of my knowledge, the survey and plan shown and described hereon is
true and correct to the accuracy required by the
(Borough of Marysville) Subdivision and Land Development Ordinance and/or Storm Water Management Ordinance.
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B. Storm Drainage Plan Certification.
I hereby certify that, to the best of my knowledge, the storm drainage facilities shown and described hereon are designed in conformance with the (Borough of Marysville) Subdivision and Land Development Ordinance and/or Storm Water Management Ordinance.
,20
C. General Plan/Report Data.
I hereby certify that, to the best of my knowledge, the (title of plan/report data) shown and described hereon is true and correct to the accuracy required by Pennsylvania State Law and the (Borough of Marysville) Subdivision and Land Development ordinance and /or Storm Water Management Ordinance.
,20
COUNCIL APPROVAL
A. (Borough of Marysville) Preliminary Plan Approval Certification at a meeting on , 20 , the Marysville Borough Council granted PRELIMINARY PLAN APPROVAL of this project, including the complete set of plans marked Sheet(s) through
which form a part of the application dated , last revised . This plan may not be recorded in the office of the Perry County Recorder of Deeds, nor may any construction be initiated but when combined with the other necessary approvals and permits, grants of authority to install on the Public Improvements required as part of the plan.
Marysville Borough Council Signature Marysville Borough Council Signature
B. (Borough of Marysville) Final Plan Approval Certification
At a meeting on , 20 , the (Marysville Borough)
approved this project, and all conditions have been met. This approval includes the complete set of plans and information that are filed with the Municipality in File No. , based upon its conformity with the standards of the (Borough of Marysville) Subdivision and
Land Development Ordinance and Storm Water Management Ordinance.
Council President Secretary
C. (Borough of Marysville Planning Commission Review Certification
At a meeting on , 20 , the
Borough of Marysville Planning Commission reviewed this plan.
Planning Commission Chair Planning Commission Secretary
D. Borough of Marysville Engineer Review Certificate
Reviewed by the Borough of Marysville Engineer.
Borough Engineer Date
PERRY COUNTY APPROVAL
A. Perry County Planning Commission Review Certificate
The Perry County Planning Commission, as required by the Pennsylvania Municipalities Planning Code,
Act 247 of 1968, as amended, reviewed this plan on , 20 , and copy of the
review is on file at the office of Perry County Planning Commission. File No. . This
certification does not indicate approval or disapproval of the plan by the Perry County Planning Commission, and the Commission does not represent nor guarantee that this plan complies with the various ordinances, rules, regulations, or laws of the local Borough, the Commonwealth, or the Federal Government.
Chairman Designee signature Vice Chairman Designee signature
B. Perry County Recorder of Deeds Certificate
Recorded in the office for Recording of Deeds, in and for Perry County, Pennsylvania, in instrument number , Volume , Page . Witness my hand and seal of office this day of A.D. 20 .
Recorder
(Ord. 614, 5/11/2015)